This 32YO male complained of decreased vision in his right eye for 2 weeks. Vision was 20/20 OD and 20/20 in his normal OS.
Fundus fluorescein angiography shows a broad zone of temporal midperipheral leaking retinal telangiectasia with capillary dropout and distal temporal ischemia. Larger retinal vessel anastomoses are present at the border of the perfused and nonperfused retina. There is also late temporal macular leakage. Color photography is unfortunately not available, and our patient was immediately lost to follow-up.
Learning Points:
Described by George Coats in 1908, Coats disease is an idiopathic disorder, usually unilateral, in males. It is characterized by retinal vascular telangiectasia involving capillaries, arterioles, and venules. Patients can present with a wide range of findings, from minimal exudation to total exudative retinal detachment. The leaking vessels are usually treated to prevent exudative complications.
Thermal laser photocoagulation is usually the initial treatment modality, but anti-VEGF injections can also be used to stabilize the vascular leakage. Treatment involves a combination of focal laser to the leaking vascular abnormalities along with scatter laser into areas of ischemia. Patients will often require multiple rounds of treatment. See Sigler et al for a review of the current management (Survey Ophthalmology 2014;59:30-46).
